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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Percutaneous coronary intervention in patients with documented coronary vasospasm during long-term follow-up
Ju Hyeon Kim1, Jinoh Park2, Yujin Yang3
1Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
Insights
Coronary artery spasm (CAS) is a risk factor for developing fixed stenosis requiring percutaneous coronary intervention (PCI). Physicians should carefully monitor patients with documented CAS, even with initially insignificant stenosis.
Area of Science:
- Cardiology
- Vascular Medicine
- Interventional Cardiology
Background:
- The link between coronary artery spasm (CAS) and fixed atherosclerotic coronary stenosis (FS) is not fully understood.
- CAS may precede or contribute to the development of significant coronary artery disease.
Purpose of the Study:
- To evaluate the incidence of fixed stenosis requiring percutaneous coronary intervention (PCI) in patients with documented CAS.
- To analyze the clinical features of patients with CAS and subsequent need for PCI.
Main Methods:
- Analysis of clinical data from 3556 patients with a median follow-up of 9.4 years.
- Utilized non-invasive ergonovine spasm provocation testing with echocardiography (erg echo) to document CAS.
Main Results:
- Coronary artery spasm (CAS) was documented in 23.3% of patients, who had more coronary risk factors.
- Patients with CAS had significantly lower 10-year overall and PCI-free survival rates.
- Documented CAS independently predicted the need for later PCI, with high concordance between initial spasm and later PCI territories.
Conclusions:
- Coronary artery spasm (CAS) is a significant risk factor for developing fixed stenosis requiring PCI.
- Vigilant follow-up is crucial for patients diagnosed with CAS, especially those with initially mild stenosis.
Objective:
Although recurring coronary artery spasm (CAS) may lead to the development of fixed atherosclerotic coronary stenosis (FS), the relationship between coronary atherosclerosis and CAS is still speculative. We evaluated the incidence of FS requiring percutaneous coronary intervention (PCI) in patients with documented CAS during long-term follow-up and analysed their clinical features.
Methods:
Clinical data of 3556 patients during a median follow-up of 9.4 years after non-invasive ergonovine spasm provocation testing with echocardiographic monitoring of left ventricular wall motion (erg echo) were analysed.
Results:
Erg echo documented CAS in 830 (23.3%) patients, who had higher frequencies of coronary risk factors than those without CAS. Patients with documented CAS on erg echo showed significantly lower 10-year overall (90.5% vs 94.2%, p<0.001) and PCI-free (97.4% vs 98.4%, p=0.002) survival rates than those without CAS. Documented CAS was an independent factor associated with later PCI after adjustment by either Cox regression model or Fine-Gray competing risk model. There was no significant difference in baseline clinical characteristics between patients who needed later PCI and those who did not. Among 28 patients who needed later PCI after documentation of CAS, the original CAS and later PCI territory were concordant in 25 (89.3%), while 3 (10.7%) showed discordance.
Conclusions:
CAS is a risk factor for the development of FS requiring PCI during long-term follow-up, and warrants physicians' vigilance and careful follow-up of patients with documented CAS and insignificant stenosis of major epicardial coronary arteries at the time of initial diagnosis.
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